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EDITORIAL: Healthcare Reforms in Nigeria; A Mere Political Statement Lacking Commitment

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By  Manny Ita

Nigeria has since her independence in 1960 had a very robust verbiage or policies by successive gobernments on health reforms but with very little progress or success recorded in what might well be a lack of political will in reforming the health sector.
Over 90% of the Nigerian population are without health insurance coverage. The inability to effectively address the country’s numerous public health challenges has contributed to the persistent and high level of poverty and weakness of the health system.
Political instability, corruption, limited institutional capacity and an unstable economy have also been major factors responsible for the poor development of health services in Nigeria. Households and individuals in Nigeria bear the burden of a dysfunctional and inequitable health system – delaying or not seeking health care and having to pay out of pocket for health care services that are not affordable.
The health challenges of the country include:
National Health Insurance Scheme (NHIS),
National Immunisation Coverage Scheme (NICS),
Midwives Service Scheme (MSS)
Nigerian Pay for Performance scheme
After many attempts at implementing legislation on health insurance since 1960, NHIS, although established in 1999, was eventually launched only in 2005 with the goals to ensure access to quality health care services, provide financial risk protection, reduce rising costs of health care services and ensure efficiency in health care through programmes such as the: Formal Sector Social Health Insurance Programme (FSSHIP), Mobile Health, Voluntary Contributors Social Health Insurance Programme (VCSHIP), Tertiary Institution Social Health Insurance Programme (TISHIP), Community Based Social Health Insurance Programme (CBSHIP), Public Primary Pupils Social Health Insurance Programme (PPPSHIP), and the provision of health care services for children under 5 years, prison inmates, disabled persons, retirees and the elderly.
The NHIS was expected to provide social and financial risk protection by reducing the cost of health care and providing equitable access to basic health services with the most vulnerable populations in Nigeria including children, pregnant women, people living with disabilities, elderly, displaced, unemployed, retirees and the sick.
Free health care services and exemption mechanisms are expected to provide financial risk protection for the most vulnerable populations but evidence suggest that they are ineffective and have failed to achieve this aim.
The maternal mortality ratio for Nigeria remain quite high at 814 per 100000 live births according to 2016 World Health Statistics. Across the country, pregnant women and children under five years are generally charged fees when accessing health care services, despite the federal government’s declaration of free health for pregnant women and children under five years in 2005.
The Minister of Health, Professor Isaac Adewole in 2016 announced the Federal Government’s plan to provide free health services to 100 million Nigerians in the next two years. Under this new health agenda, pregnant women across Nigeria are expected to enjoy free maternal and delivery services at the primary health care (PHC) level.
Unfortunately, Free health care services and exemption mechanisms often arise as campaign promises of political actors to the electorate and fall short in meeting the health needs of the most vulnerable populations. According to Nigeria Demographic Health Survey (NDHS) in 2013, over 60% of pregnant women aged 15-49 deliver their babies at home without any antenatal care visits. In rural areas, this value reaches 76.9%. The situation is critical in North East and North West regions of Nigeria where over 79% of pregnant women age 15-49 deliver their babies at home. Over 60% of pregnant women in Bayelsa, Plateau and Niger deliver at home rather than a health facility.
The cost of health care and the low quality of care by the public have been argued to be the reason for the poor utilisation of maternal and child health services in Nigeria.
In addition, health spending in Nigeria is low and this is responsible for the over-reliance on out of pocket payments for health care services.
Despite its launch in 2005, NHIS covers less than 10% of the Nigerian population leaving the most vulnerable populations at the mercy of health care services that are not affordable. This means the most vulnerable populations in Nigeria are not provided with social and financial risk protection. Poor people constitutes about 70% of the Nigerian population. They lack access to basic health services, which social and financial risk protection should provide, because they cannot afford it.
CBSHIP was expected to meet their health needs as well as provide social and financial risk protection to this group, which mostly reside in rural areas. As evidenced in the high rate of out of pocket payments for health care services , poor people financially contribute more to health care than official care and funds programmes in Nigeria. Out of pocket payments for health care services limit the poor from accessing and utilising basic health care services.
The quality of health care services delivered is poor and remains a huge source of concern. Most of the PHC facilities that are supposed to meet the health needs of the poor and rural dwellers are in a poor state due to poor budgetary allocation.
In trying to solve these issues, healthcare in the country must be tackled headlong in order to stem the detyeriorating development therein, which could portend grave danger for citizens of the country in the no-ditant future.
Policy makers and political actors need to devise health care reforms to address the lack of social and financial protection for the poor and vulnerable populations. Part of this reform is the expansion of the NHIS. States should be mandated to provide health insurance coverage to all residents. Making health insurance optional for states over the years has affected the ability of the NHIS to increase the level of coverage for the people.
While the mandatory CBHI scheme is being scaled-up as a supplementary measure, state governments should enrol poor residents in a private health insurance plan and bear the responsibility of paying the monthly premium per person to Health Maintenance Organisations (HMOs). It is not enough to have a national health insurance policy, it is important to ensure that health insurance coverage is provided to the poor and most vulnerable populations as a matter of the human right to health.
Although the NHIS Act made provision for children, who constitute the largest population in Nigeria, many children still have to pay for health care services in spite of being born into poor families that do not have the ability to pay for health care services and suffer financial hardship as a consequence. The free health policies and exemption mechanisms provided by some states, targeted at children, pregnant women and the elderly, are not social and financial risk protection policies, as these groups are largely responsible for the cost of health care with the free health care programme barely covering their basic health care services.
Another way of providing social and financial risk protection for poor and vulnerable populations is by establishing a legislative framework for a UHC scheme and setting aside funds for it. Evidence from Thailand has shown the effect of UHC schemes through PHC on expanding access to health care for the poor and vulnerable populations.
Political actors, policy makers and all stakeholders in the health sector should establish a government funded social and financial risk protection scheme through a general tax financing system for the poor and vulnerable, and invest in basic infrastructure for health care in rural areas for quality health care service delivery. UHC schemes are important in addressing the problem of poor coverage, limited access to health care, and poor quality of health care services.
Nigeria is yet to adopt innovative ways to protect the poor and vulnerable populations against financial risk of ill health. It is important to guarantee by law the right to health care of all citizens in Nigeria. Although the National Health Act (NHA) that was signed into law in 2014 stated that all Nigerians are entitled to basic minimum package of health care services, it is not clear if the provisions made in the NHA are capable of achieving UHC in Nigeria. In addition, the NHA is yet to be implemented over two years after its signage into law.
Some low- and middle-income countries (LMICs) have been able to provide social and financial risk protection schemes for poor and vulnerable populations as a matter of the human right to health. Therefore, there is a need to provide social health protection schemes targeted at these groups in Nigeria. The poor and vulnerable populations should not become impoverished because of failure to obtain much needed health care services. Governments must reduce out of pocket payments for health care services by households through the adoption of a tax financed non-contributory UHC scheme.

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Security Update

SARS Is The Most Successful Unit On The Force….IG

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The Acting Inspector General (IG) of Police, Mohammed Adamu, said in Benin City on Monday that the Special Anti-Robbery Squad (SARS) has contributed up to 80 per cent of the successes recorded by the Nigeria Police Force.

Adamu made the remark at the commencement of a three-day Human Rights Training Programme for officers of SARS in Edo.

The IG, represented by CP Abiodun Odube, Commissioner of Police in charge of Training and Development, said this was in spite of the protests by Nigerians against the activities of SARS.

He noted that one area of conflict between the public and SARS was in the area of human rights.

The IG said the training was, therefore, a holistic approach to enhance the performance of the squad.

He also said that the force was committed to the training and re-training of its officers and men across the country to respect the human rights of the citizens.

According to him, the training seeks to improve professionalism of officers, who are expected to take the training down to their subordinates and the rank-and-file.

He stressed that the training was part of a holistic reform to get police personnel adequately equipped to discharge their duties and win the trust of Nigerians.

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Security Update

Kano CP Apologises To NBA Over illegal Arrest

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The Kano state Commissioner of Police, Mohammed Wakili has on Thursday apologised to the Nigerian Bar Association (NBA) over molestation and unlawful arrest of its members by policemen.

The apology came barely 24 hours to expiration of a 48-hour ultimatum by the Kano NBA to Wakili.

The Nation reports the NBA in a statement on Wednesday said armed policemen had molested and arrested its members working at an election petition secretariat.

The association also accused Wakili of being partisan in the discharge of his duty.

However, on receiving the information about the ultimatum, the commissioner appeared at the NBA secretariat on today to tender an unreserved apology.

Speaking to newsmen after the visit, Wakili said he decided to come by himself to say sorry after he investigated the incident that led to the arrest and detention of two lawyers.

“After receiving the complaint and even heard it through the media, I launched an investigation and found that they were unlawfully arrested.

“Therefore, I deemed it fit to go there myself and tender my apology. I am a Police man who discharges his duty within the concept of law,” he said.

The CP also urged the association and other people to challenge him whenever he goes contrary to law.

The state secretary of the association, Mujtaba Adamu-Ameen, commended the CP for the gesture, describing him as a professional and ethical cop.

“As you can see, the CP abided by our ultimatum. He came here and apologised. This show that he is a professional and disciplined Corp,” he said

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Headline

President Buhari Needs Four More Years to Finish his Task….Garba

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– Garba, Deputy Chairman, APC Progressives Network
 
Awwal Garba A. D. is a Nigerian and British trained Economist of a rare breed.  He attended the Bayero University Kano, Nigeria and the City University, London, United Kingdom, from which institutions he meritoriously obtained his first and second university degrees.
 
Awwal is a major player in the global oil and gas sector. With particular interest in Nigeria, he has developed a proclivity for discovering untapped resources within the sector and has over the years, successfully built his chain of business interests under the Magma Group, nationally and globally.
 
He is also the Deputy Chairman, APC Progressives Network and Chairman, Game Changers Media.
 
In this interview, while advising politicians to stop politics of money and vote –buying as 2019 elections approach, Awwal Garba also bares his mind on the APC Government, the political terrain, as well as other sundry issues.
 
Excerpts:
 
You are an economist into oil and gas operations, what informed your foray into the terrain?
 
Apart from the motive of making money, I have an affinity with the oil and gas sector of the economy; I look at there as where I belong, although I come from a family where the stock in trade was commodity. My father was an importer and exporter of commodity products.
I was motivated into the sector by the desire to make a change, especially in the upstream sector of the industry where it is believed that it is only the oyibos (foreigners) that hold sway therein.
Of course also in that direction would be the desire to contribute one’s quota to the national economy, in terms of creating jobs, which of course would help in giving the youths a sense of worth and direction.
 
Tell us about the APC Progressives Network, which you chair
 
The network has an endorsement from the All Progressives Congress to promote the president and contribute with ideas. Of course, you would agree that in campaigning you need ideas. Politics is all about people, followers; people who can bring in value. In the same vein, the network tries to reach the grassroots and places the party has not touched, bringing in more value.
 
What are your plans for 2019 elections?
 
It is to ensure that there are free and fair elections. We want to make sure about that because we know that if the elections are free and fair, President Buhari will continue in office. He’ll win the election.
 
Does he deserve a second term and why?
 
Yes, he deserves a second term. First of all, we need a leader who is clean because when the head is clean, the middle and bottom will also be because they would be put in a position where they are wary. But if the top is rotten, then it is corruption galore. We need a leader like Buhari whom money does not mean anything to. A president who is so humble, he can even stand with cows. He is simple, not extravagant, qualities he has officially demonstrated which can be widely attested to. I believe that with him coming back, God sparing his life, he will achieve a lot.
 
Do you have any political ambition?
No. I am more on the kingmaker’s side.
 
Why?
Because I enjoy what I do and I believe that political adventure would not allow me the concentration I need on my business operations. I would not be able to achieve set goals by not being on top of them. Besides, no other office really excites me. Being a president of Nigeria would not excite me. I am missing nothing in life.  I love the freedom I have. I can drive myself and travel when I want to, jump on a plane without the glare associated with a president’s office, without the entourage and all the protocol.
 
As Deputy Chairman of Game Changers Media, what is its unique selling point?
 
The Game Changer was established to highlight the differences and show that the Muhammadu Buhari administration continues to change the whole game; from Agriculture, Corruption to Healthcare and very importantly, to unite Nigerians and give them a sense of belonging, while stoking the embers of patriotism.
If you go to Ghana today, you will be shocked to realise the level of their patriotism. A taxi driver always has the Ghanaian flag in his cab as every household, like it was in America perhaps before the Trump era when American schools taught American history, the need to be patriotic and love for country. So patriotism is very important. Game Changer is here to bring awareness about patriotism.
 
Being such a busy person, do you find time to wind down?
 
When I was in my 20’s, I used to be a gym fanatic and could not do without the gym. I also played polo. The pressure of work increased with growth and time for things like that shrank. So whatever time I can squeeze out now for personal issues, I spend it with my wife and two children. We take the children to game parks when they are on holidays and try to have a feel of their minds by coming down to their level and appreciating them.
 
What is your advice to politicians as we await the 2019 elections?
We should stop the politics of money and vote-buying. We should allow Nigerians to vote for candidates of their choice without influencing them. It is a disgrace to buy one’s way into a public office. When that happens, you look at yourself as a businessman and begin to fashion out ways to recoup spent money. This is what has been happening for ages. Only a person voted in by merit would think of improving the lives of the people.
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